Most US women who gave birth have unfavorable heart health before pregnancy
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In 2019, most U.S. women who gave birth did not have favorable cardiometabolic health before pregnancy, researchers reported in a Go Red for Women spotlight edition of Circulation.
“Many women only begin having regular health care visits once they become pregnant. If women already have overweight or obesity, high blood pressure or diabetes prior to pregnancy, it is often not diagnosed until pregnancy. However, if identified prior to pregnancy, their health care clinician can help them manage and optimize these conditions before pregnancy,” Natalie A. Cameron, MD, internal medicine specialist and instructor at Northwestern University Feinberg School of Medicine, said in a press release. “Being in good health prior to pregnancy benefits the long-term health of women and their children. Poor maternal heart health is related to poor outcomes for babies at birth, such as being born early or at a smaller weight for their gestational age, and it is also linked to poor heart health later in life for these children. This connection between maternal heart health and offspring heart health, even years after pregnancy, comes as a surprise to many.”
The analysis included more than 14 million live births (81% aged 20 to 34 years; 23% Hispanic; 14% Black) from 2016 to 2019 included in the CDC’s Natality Database. All participants were aged 20 to 44 years and had data on prepregnancy BMI, diabetes and hypertension.
Cameron and colleagues defined favorable cardiometabolic health as follows: normal weight, defined as BMI 18 kg/m2 to 24.9 kg/m2; absence of diabetes; and absence of hypertension. In a secondary analysis, absence of smoking was added to the definition.
From 2016 to 2019, the prevalence of favorable cardiometabolic health per 100 live births declined from 43.5 (95% CI, 43.4-43.6) to 40.2 (95% CI, 40.1-40.2), according to the researchers. The decline was observed in all age groups, and the prevalence of favorable cardiometabolic health was highest in women aged 30 to 34 years and lowest in women aged 40 to 44 years.
The decline occurred in all U.S. regions in states, but the prevalence of favorable cardiometabolic health varied by region and state, Cameron and colleagues wrote. In 2019, by region, prevalence ranged from 38.2 per 100 live births (95% CI, 38.1-38.3) in the South to 43.6 (95% CI, 43.5-43.7) in the Northeast, and by state, prevalence ranged from 31.2 per 100 live births (95% CI, 30.7-31.7) in Mississippi to 47.2 (95% CI, 46.7-47.6) in Utah, they wrote.
In 2019, favorable cardiometabolic health was inversely correlated with state-level percent of high school education or less (r = –0.62; P < .01) and enrollment in Medicaid (r = –0.52; P < .01), according to the researchers.
The prevalence and trends of favorable cardiometabolic health were similar in nulliparous individuals compared with the overall population, and geographic and temporal patterns did not change when nonsmoking status was added to the definition of favorable cardiometabolic health, the researchers wrote.
“These geographic patterns are, unfortunately, very similar to what we see for heart disease and stroke in both men and women, and they indicate that social determinants of health play a critical role in maternal heart health as well,” Sadiya S. Khan, MD, MS, FACC, FAHA, assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine, said in the release. “In addition to optimizing health for those interested in becoming pregnant, it’s important to focus on optimizing cardiovascular health throughout young adulthood because nearly half of pregnancies are unplanned. We need to emphasize heart health across the life span.”
For more information:
- Most people giving birth in the U.S. have poor heart health prior to pregnancy. newsroom.heart.org/news/most-people-giving-birth-in-the-u-s-have-poor-heart-health-prior-to-pregnancy?preview=dba9. Posted Feb. 14, 2022. Accessed Feb. 14, 2022.
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These are critically important data. However, it seems clear that waiting until women become pregnant is too late. The restoration of health classes in high school or even before, Brownies, girls’ clubs, sororities and even community-based activities (eg, local health fairs, TV bulletin boards, social media, youth sports programs, etc) could make an important impact.
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Garima V. Sharma, MD, FACC, FACP
These findings are important for preventive cardiologists and cardio-obstetrics clinicians. More than half of women 20 to 44 years of age who gave birth in the U.S. in 2019 had at least one CV risk factor, including overweight/obesity, hypertension or diabetes, before becoming pregnant. In other words, optimal CV health is a concern for women of reproductive age. These are important findings that should be addressed while providing antenatal care to women. The postpartum time frame is an additional opportunity, as well as advancing postpartum care and interpregnancy care.
Doctors need to focus on prevention and address CV health risk factors in pregnancy and during preconception counseling. Improving health literacy of our patients is important. Empowering our patients to make healthy choices and addressing risk factors is of paramount importance.
These findings are concerning and need to be taken in the context of the social determinants of health of the pregnant people. There are many barriers to achieving optimal CV health, especially for those in rural and inner-city settings. These women are young, and focusing on implementation of interventions to change their CV health should be studied.
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